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Peer-reviewedCC BY-NC-ND 4.0BMC Cancer

Association between neoadjuvant and adjuvant chemotherapy and severity of breast cancer-related lymphedema following axillary lymph node dissection

  • Ramesh Omranipour1,2
  • Mohammadamin Bayat1,3
  • Sadaf Alipour1,4
  • Fatemeh Banigol5
  • Saeedeh Sarli6
  • Shiller Hessamiazar1
  • Mahta Mohammadzadeh1
  • Bita Eslami1
6 affiliations
  1. 1Breast Diseases Research Center (BDRC), Cancer Institute, Imam Khomeini Complex Hospital, Tehran University Medical of Sciences, Tehran, Iran
  2. 2Department of Surgical Oncology, Cancer Institute, Tehran University Medical of Sciences, Tehran, Iran
  3. 3Faculty of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
  4. 4Department of Surgery, Arash Women’s Hospital, Tehran University Medical of Sciences, Tehran, Iran
  5. 5Physiotherapy Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  6. 6Sarli Clinic, Tehran, Iran
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Abstract

Background: Breast Cancer-Related Lymphedema (BCRL) is one of the most frequent complication after axillary lymph node dissection (ALND). The aim of this study was to evaluate the severity of BCRL in patients with established BCRL following ALND, focusing on the timing of chemotherapy relative to the surgery (neoadjuvant vs. adjuvant), in the presence of other factors affecting BCRL.

Methods: This cross-sectional study included 664 breast cancer patients with established BCRL following ALND who were referred to two physiotherapy centers. BCRL was determined by measurements of arm circumferences. Volume differential (VD) between the two arms was classified as 5–10%, 11–30%, and > 30%.

Results: Overall, 41.9% (n = 278), 36.9% (n = 245) and 21.2% (n = 141) of patients had severe, moderate and mild BCRL, respectively. Although VD was higher in the adjuvant than the neoadjuvant group, there were no statistically significant differences between two groups (30.92 ± 23.20 vs. 26.32 ± 17.42, Z=-1.59, p = 0.11). Furthermore, the median interval between surgery and lymphedema diagnosis was longer in the adjuvant group, with a median time of 19 months compared to 12 months (Z=-7.23, p < 0.001). Multivariable logistic regression analysis showed a lower odds of severe BCRL in the neoadjuvant group compared to adjuvant (OR = 0.36, 95%CI = 0.14–0.94, p = 0.04). Age, radiotherapy, and the number of involved lymph nodes were significantly associated with high severity of BCRL. Additionally, the rate of severe lymphedema in patients who adhered to preventive measures was significantly lower than in those who did not (27.9% vs. 53%, p < 0.001).

Conclusion: Among breast cancer patients with established BCRL following ALND, those who received neoadjuvant chemotherapy were less likely to experience severe lymphedema than patients treated with adjuvant chemotherapy. Older age, radiotherapy, and a greater number of involved nodes were identified as factors linked to increased lymphedema severity. Conversely, adherence to preventive measures was related to a lower likelihood of severe BCRL. Further prospective studies are needed to confirm these findings and clarify the underlying mechanisms.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12885-026-16718-4.

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Cite

BibTeXRIS
BibTeX
@article{omranipour2026association,
  title = {{Association between neoadjuvant and adjuvant chemotherapy and severity of breast cancer-related lymphedema following axillary lymph node dissection}},
  author = {Ramesh Omranipour and Mohammadamin Bayat and Sadaf Alipour and Fatemeh Banigol and Saeedeh Sarli and Shiller Hessamiazar and Mahta Mohammadzadeh and Bita Eslami},
  journal = {BMC Cancer},
  year = {2026},
  month = aug,
  doi = {10.1186/s12885-026-16718-4},
  url = {https://doi.org/10.1186/s12885-026-16718-4},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Association between neoadjuvant and adjuvant chemotherapy and severity of breast cancer-related lymphedema following axillary lymph node dissection
AU  - Ramesh Omranipour
AU  - Mohammadamin Bayat
AU  - Sadaf Alipour
AU  - Fatemeh Banigol
AU  - Saeedeh Sarli
AU  - Shiller Hessamiazar
AU  - Mahta Mohammadzadeh
AU  - Bita Eslami
PY  - 2026
DA  - 2026/08/10
JO  - BMC Cancer
DO  - 10.1186/s12885-026-16718-4
UR  - https://doi.org/10.1186/s12885-026-16718-4
AB  - Background: Breast Cancer-Related Lymphedema (BCRL) is one of the most frequent complication after axillary lymph node dissection (ALND). The aim of this study was to evaluate the severity of BCRL in patients with established BCRL following ALND, focusing on the timing of chemotherapy relative to the surgery (neoadjuvant vs. adjuvant), in the presence of other factors affecting BCRL.  Methods: This cross-sectional study included 664 breast cancer patients with established BCRL following ALND who were referred to two physiotherapy centers. BCRL was determined by measurements of arm circumferences. Volume differential (VD) between the two arms was classified as 5–10%, 11–30%, and > 30%.  Results: Overall, 41.9% (n = 278), 36.9% (n = 245) and 21.2% (n = 141) of patients had severe, moderate and mild BCRL, respectively. Although VD was higher in the adjuvant than the neoadjuvant group, there were no statistically significant differences between two groups (30.92 ± 23.20 vs. 26.32 ± 17.42, Z=-1.59, p = 0.11). Furthermore, the median interval between surgery and lymphedema diagnosis was longer in the adjuvant group, with a median time of 19 months compared to 12 months (Z=-7.23, p < 0.001). Multivariable logistic regression analysis showed a lower odds of severe BCRL in the neoadjuvant group compared to adjuvant (OR = 0.36, 95%CI = 0.14–0.94, p = 0.04). Age, radiotherapy, and the number of involved lymph nodes were significantly associated with high severity of BCRL. Additionally, the rate of severe lymphedema in patients who adhered to preventive measures was significantly lower than in those who did not (27.9% vs. 53%, p < 0.001).  Conclusion: Among breast cancer patients with established BCRL following ALND, those who received neoadjuvant chemotherapy were less likely to experience severe lymphedema than patients treated with adjuvant chemotherapy. Older age, radiotherapy, and a greater number of involved nodes were identified as factors linked to increased lymphedema severity. Conversely, adherence to preventive measures was related to a lower likelihood of severe BCRL. Further prospective studies are needed to confirm these findings and clarify the underlying mechanisms.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12885-026-16718-4.
SN  - 1471-2407
ER  -